EP0979098B1 - Verfahren zur behandlung von hyperprolaktinämia und prolaktinomen - Google Patents

Verfahren zur behandlung von hyperprolaktinämia und prolaktinomen Download PDF

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EP0979098B1
EP0979098B1 EP98918696A EP98918696A EP0979098B1 EP 0979098 B1 EP0979098 B1 EP 0979098B1 EP 98918696 A EP98918696 A EP 98918696A EP 98918696 A EP98918696 A EP 98918696A EP 0979098 B1 EP0979098 B1 EP 0979098B1
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Prior art keywords
prolactin
receptor
agonist
somatostatin
treating
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French (fr)
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EP0979098A1 (de
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Shlomo Melmed
Ilan Shimon
Michael D. Culler
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Ipsen Pharma SAS
Cedars Sinai Medical Center
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Cedars Sinai Medical Center
Ipsen Bioscience Inc
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K38/00—Medicinal preparations containing peptides
    • A61K38/16—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof
    • A61K38/17—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans
    • A61K38/22—Hormones
    • A61K38/31—Somatostatins
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P15/00—Drugs for genital or sexual disorders; Contraceptives
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P15/00—Drugs for genital or sexual disorders; Contraceptives
    • A61P15/10—Drugs for genital or sexual disorders; Contraceptives for impotence
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P35/00—Antineoplastic agents
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P43/00—Drugs for specific purposes, not provided for in groups A61P1/00-A61P41/00

Definitions

  • This invention relates to the field of hyperprolactinemias, and prolactinomas. More specifically, this invention relates to the use of somatostatin type-5 recptor agonists for the treatment of a subject afflicted with either condition, and to the lowering of prolactin levels and/or the size of the tumor by administration of a selected family of pharmaceuticals.
  • Prolactin hypersecretion, or hyperprolactinemia may have anyone of a number of functional causes, including various neurogenic causes such as thoracic sensory nerve stimulation, stress, and psychogenic causes, various hypothalamic causes such as diffuse processes, granulomatous diseases, neoplasms, stalk section, empty sella, non-lactotropic cell pituitary tumors, and prostradiation treatment to sella, various pituitary causes such as prolactinomas and pituitary lactotropic cell hyperplasia, and various endocrine causes such as pregnancy, estrogen administration, hypothyroidism, and adrenal insufficiency.
  • various neurogenic causes such as thoracic sensory nerve stimulation, stress, and psychogenic causes
  • various hypothalamic causes such as diffuse processes, granulomatous diseases, neoplasms, stalk section, empty sella, non-lactotropic cell pituitary tumors, and prostradiation treatment to sella
  • various pituitary causes such as prolactinomas and pit
  • Prolactin hypersecretion may also be caused by the administration of drugs which impair dopamine secretion, such as psychotropic drugs, antihypertensive drugs, antiemetic drugs, H 2 -receptor blockers, and opiates, among others.
  • drugs which impair dopamine secretion such as psychotropic drugs, antihypertensive drugs, antiemetic drugs, H 2 -receptor blockers, and opiates, among others.
  • Prolactinomas are pituitary tumors, in fact, the most common pituitary tumors, which are almost five times more common in women than in men. Some prolactinomas respond to, and may be treated with, the dopamine agonist, Bromocriptine. One-third of the patients afflicted with prolactinomas, however, do not respond to, and are therefore not treatable with, this drug. The latter are usually referred for pituitary surgery and/or, rarely, irradiation.
  • Somatostatin also known as somatotropin release inhibiting factor or SRIF, is believed to exert its biological effect through a family of G-protein associated receptors provided with seven transmembrane domains. Somatostatin inhibits the secretion of growth hormone.
  • SSTR somatostatin receptor
  • Five subtypes of the somatostatin receptor (SSTR) have already been cloned, and named SSTR-1, SSTR-2, SSTR-3, SSTR-4, and SSTR-5.
  • the SSTR-1, SSTR-2, and SSTR-5 receptors have been shown to be expressed by the human pituitary gland, and the SSTR-1, SSTR-2, SSTR-3 and SSTR-5 receptors by human pituitary adenomas.
  • SSTR-2 selective somatostatin agonists were shown to inhibit prolactin secretion from normal fetal pituitary cultures, as it is described e. g. in J. Clin. Invest. 99, 789-798 (1997).
  • the present invention relates to the use of a therapeutically effective amount of one or more somatostatin type-5 receptor (SSTR-5) agonist(s) according to claim 1, such as a somatostatin type-5 selective agonist for the manufacture of a medicament for treating hyperpmlactinemia and/or a prolactinoma in a subject which may be a mammal, such as a human.
  • SSTR-5 somatostatin type-5 receptor
  • This administration for example, lowers abnormally high levels of prolactin in the subject's blood.
  • the medicament for example, lowers either tumor prolactin secretion and/or decreases tumor size, in the subject.
  • the present medicament is effective in subjects afflicted by hyperprolactenemia, and particularly those who have abnormally high levels of prolactin, for example, as a result of one or more of the following: a pituitary tumor such as a prolactinoma, hypothalamic and pituitary stalk disease, hyperthyroidism, postparrum lactation, decreased dopamine or dopamine inhibitory action, which may be caused by the administration of drugs such as opiates and psychotropic drugs, among others, stimuli that overcome the normal dopamixiergic inhibition such as the administration of estrogen, decreased clearance of prolactin such as in renal failure or cirrhosis, seizures, and chest wall trauma, among others.
  • the present family of drugs lowers prolactin levels, it also consequently, treats the galactorrhea, amenorrhea, infertility, impotence, and/or hypogonadism, which many times accompany it.
  • the somatostatin agonist While it is possible for the somatostatin agonist to be administered as the pure or substantially pure compound, it may also be presented as a pharmaceutical composition, formulation or preparation.
  • the composition of the invention comprises one or more of a selected class of somatostatin agonists, and one or more pharmaceutically acceptable carriers for the agonists, and optionally other therapeutic agents.
  • the somatostatin agonist may be formulated for administration by various routes, including by a parenteral route such as an intravenous, subcutaneous, or intramuscular route, or by implantation of a sustained release formulation, among others.
  • the carrier must be "acceptable" in that it has to be compatible with, and stabilizing of, the active ingredient(s) of the formulation, and not deleterious to the subject to be treated.
  • the present invention arose from a desire by the inventors to improve on prior art treatments for hyperprolactinemias associated with various causes, including prolactinomas.
  • This invention thus, relates to the discovery that SSTR-5 somatostatin agonists, but not SSTR-2 somatostatin agonists, are capable of reducing serum prolactin levels, and inhibiting prolactin secretion in a subject which is in a state of pathological hyperprolactinemia, such as in the case of a subject carrying a prolactinoma.
  • This invention therefore, provides a medicament for treatment of hyperprolactinemias in general, and of prolactinomas in particular, in animals, including mammals such as humans.
  • the invention counters by the administration of a selected group of pharmaceuticals the conditions afflicting the subject, and lowers prolactin blood levels and/or tumor size.
  • the present inventors are providing the use of a therapeutically effective amount of one or more somatostatin type-5 receptor (SSTR-5) agonist(s) according to claim 1, such as a somatostatin type-5 selective agonist for the manufacture of a medicament for treating hyperprolactinemia and/or a prolactinoma in a subject.
  • SSTR-5 somatostatin type-5 receptor
  • “Therapeutic amounts of the agonists of the invention are those which decrease the pituitary secretion of prolactin, or reduce serum prolactin levels to within about the normal range.
  • the amount of the SSTR-5 agonist to be administered is intended to reduce prolactin serum levels to about 0 to 50 ng/ml blood, as detected by an immunoradiometric assay (IRMA), or in some instances even above 50 ng/ml, and more preferably below 70 ng/ml blood.
  • Still a more preferred therapeutic amount of the agonists of the invention are those that permit lowering the prolactin serum levels to about 2 to 30 ng/ml blood, and more preferably to about 5 to about 20 ng/ml blood.
  • a “therapeutic amount" of the agonist of the invention for the treatment of prolactinomas is meant as that dose which reduces the size of the tumor by at least about 30%, more preferably by about more than about 50%, and still more preferably by more than about 80% or more. In some instances, however, there is a complete or almost complete disappearance of the tumor, as detected by MRI.
  • the present treatment affords a reduction of about 4-50% of large tumors, 4-5 cm in diameter. In smaller tumors, of about 1 cm in diameter, this treatment may attain a significant reduction in size, detectable to about 2 mm. In some instances, smaller tumors may be less responsive than larger tumors to the present treatment.
  • the amount of drugs to be administered in this invention which is considered to be therapeutically effective clearly depends upon the condition being treated, the route of administration chosen, and the specific activity of the compound used. This is a matter which is ultimately best decided by the attending physician or veterinarian.
  • the somatostatin agonist is to be administered to the subject until the subject's prolactin level stabilizes to within normal levels, such as when the prolactinoma has been removed or ablated.
  • the somatostatin agonist may be administered, if necessary, for the lifetime of the patient.
  • Somatostatin or SRIF has a 14 amino acid isoform (somatostatin-14) as well as a 28 amino acid isoform (somatostatin-28). See Wilson, J. & Foster, D., Williams Textbook of Endocrinology, p. 510 (7th. Ed., 1985). Somatostatin inhibits the secretion of growth hormone, and was originally isolated from the hypothalamus. See, Brazeau, et al., Science 179:77 (1973). The native somatostatin has a very short lasting in vivo effect, because it is rapidly inactivated by endo- and exo-peptidases.
  • somatostatin Many novel agonists of somatostatin, such as peptides and non-peptidic compounds, have been prepared in order to enhance the duration of effect, and biological activity of this hormone, and selectivity for one or more particular subtype of somatostatin receptor.
  • Such somatostatin analogues are called "somatostatin agonists" for the purposes of this patent.
  • the somatostatin agonist may be a SSTR-1 agonist, SSTR-2 agonist, SSTR-3 agonist, SSTR-4 agonist, or a SSTR-5 agonist.
  • 'somatostatin type-5 receptor agonist' or SSTR-5 agonist is meant a compound which (1) has a high binding affinity, e. g., Ki less than 5 nM, and preferably less than 1 nM, for human SSTR-5, for example, as defined by the receptor binding assay described below, and (2) decreases prolactin levels in a patient, for example, as shown by the biological assay described below.
  • somatostatin agonists are those covered by formulae or those specifically recited in the publications set forth below. Van Binst, G.
  • SSTR-5 agonists include, but are not limited to the following:
  • somatostatin type-5 receptor selective agonist is meant a somatostatin agonist which (1) has a higher binding affinity, or Ki, for SSTR-5 than for either SSTR-1, SSTR-2, SSTR-3, or SSTR-4, and (2) decreases prolactin levels in a patient, for instance, as shown by the biological assay described below.
  • the SSTR-5 selective agonist has a Ki for SSTR-5 that is at least 2 times, and may be at least 10 times, less than its Ki for the SSTR-2 receptor.
  • the somatostatin type-5 receptor selective agonist is also a SSTR-5 agonist. Examples of SSTR-5 selective somatostatin agonists include, but are not limited to the following somatostatin analogs, which are disclosed in the above-cited references: and
  • each amino acid residue represents the structure of -NH-C(R)H-CO-, wherein R is the side chain of the amino acid (e.g., CH 3 for Ala). Lines between amino acid residues represent peptide bonds which join the amino acids.
  • the amino acid residue is optically active, it is the L-form configuration that is intended unless D-form is expressly designated.
  • Cpa, ⁇ -Nal, and Tyr(I) stand for the amino acids p-Cl-Phe, 2-napthylalanine, and iodinated tyrosine (e.g., 3-I-Tyr, 5-I-Tyr, or 3, 5-I-Tyr). Although a disulfide bridge forms between two free thiols of the Cys residues, this is not shown above.
  • Preferred are the peptides BIM-23268 and BIM-23052, as well as their mixture or combination. However, any of the other agonists listed above are also within the four corners of this invention.
  • the present agonists may be administered alone, or in a composition, or separately but jointly with other therapeutic agents, including other prolactin inhibitors.
  • the present method is very effective in lowering either tumor prolactin secretion and/or in decreasing tumor size, or both.
  • the present treatment is, thus, highly effective in subjects afflicted by abnormally high levels of prolactin caused by, for example, one or more of the following conditions: a pituitary tumor such as a prolactinoma, hypothalamic and pituitary stalk disease, hyperthyroidism, postpartum lactation, decreased dopamine or dopamine inhibitory action, which may be caused by the administration of drugs such as opiates and psychotropic drugs, among others, stimuli that overcome the normal dopaminergic inhibition such as the administration of estrogen, decreased clearance of prolactin such as in renal failure or cirrhosis, seizures, and chest wall trauma, among others.
  • a pituitary tumor such as a prolactinoma, hypothalamic and pituitary stalk disease, hyperthyroidism, postpartum lactation
  • decreased dopamine or dopamine inhibitory action which may be caused by the administration of drugs such as opiates and psychotropic drugs, among others, stimuli that overcome the normal dopaminergic inhibition such as the
  • the present family of drugs is also effective in the treatment of galactorrhea, amenorrhea, infertility, impotence, and/or hypogonadism, which many times are associated with increased prolactin levels.
  • the somatostatin agonist(s) of this invention may be administered as a purified, or substantially purified compound, it may also be presented as a pharmaceutical composition, formulation or preparation.
  • the composition used according to the invention comprises one or more of a selected class of somatostatin agonists, and one or more pharmaceutically acceptable carriers for the agonists, and optionally other therapeutic agents.
  • Formulations of the somatostatin agonist(s) described herein encompass those custom tailored for administration by various routes, including by a parenteral route, which may be an oral, intravenous, subcutaneous, or intramuscular route, or by implantation of a sustained release formulation, among others.
  • the carrier(s) must be "acceptable” in that it has to be compatible with, and stabilizing of, the active ingredient(s) of the formulation, and not deleterious to the subject to be treated (“pharmaceutically acceptable”).
  • the formulation should preferably be free of oxidizing agents, or other substances with which peptides are known to be incompatible.
  • Somatostatin agonists that are in their cyclized form, such as those that have an internal cysteine disulfide bond may, for example, be in their oxidized or reduced forms.
  • a reducing agent in the composition might lead to an opening of the cysteine disulfide bridge.
  • highly oxidative conditions may, for example, lead to the formation of cysteine sulfoxide, and to the oxidation of tryptophan. It is, therefore, of great importance that excipients and other components of the formulation be carefully select.
  • the pH of the composition is also of import, and it is preferable that the product be buffered under slightly acidic conditions, such as pH about 5 to about 6. These pHs, however, are not limiting.
  • the formulations for tablets or powders may be prepared by uniformly and intimately blending the active ingredient with finely divided solid carriers, and then, if necessary, as in the case of tablets, forming the product into the desired shape and size.
  • Formulations suitable for parenteral, e.g., intravenous, administration conveniently comprise sterile aqueous solutions of the active ingredient(s).
  • the solutions are, preferably, isotonic with the blood of the subject to be treated.
  • Such formulations may.
  • These and other formulation may be presented in unit or multidose form, in containers, for example, sealed ampoules or vials, among others.
  • the formulation may be prepared by any of the well known methods to the pharmaceutical artisan. All methods include the step of bringing the active ingredient(s) into association with the carrier, which constitutes one or more accessory ingredients.
  • Sustained release formulations suitable for parenteral administrations such as biodegradable polymer formulations, for example, those including polyesters containing lactic or glycolic acid residues, are also well known in the art. See, e.g., U.S. Patent Nos. 3,773,919 and 4,767,628 and PCT Publication No. WO 94/15587.
  • the somatostatin agonist used according to the invention or its composition may also be administered with another compound capable of lowering blood levels of prolactin, including dopamine agents such as Bromocriptine, cabergoline, pergolide, or lisuride, among others.
  • This compounds may be added to the same composition, or administered separately in amounts that are known in the art.
  • the amounts of the latter compounds administered will be lower than the doses which are utilized when they are administered by themselves. In other instances, however, similar doses may be utilized, which will be additive or potentiating of the present treatment.
  • the somatostatin agonist may be injected parenterally, e.g., intravenously, into the bloodstream of the subject being treated. It will, however, be readily appreciated by those skilled in the art that which route, whether intravenous, subcutaneous, intramuscular, intraperitoneal, enterally, transdermally, transmucously, sustained released polymer compositions, e. g., lactic acid polymer or lactic acid and glycolic acid copolymer microparticle or implant, perfusion, nasal, oral, etc., will depend on the condition being treated, and the activity and bioavailability of the somatostatin agonist being used.
  • the peptide H-D-Phe-Phe-Phe-D-Trp-Lys-Thr-Phe-Thr-NH2 (BIM-23052) described above may be synthesized by following the protocol set forth in Example I of European Pat. Appl. 0 395 417 A1.
  • SSTR-1 and SSTR-2 Yamada, Y., et al., P.N.A.S. USA, 89: 251-255 (1992); SSTR-3: Yamada, et al., Mol. Endocrinol. 6: 2136-2142 (1993); and SSTR-4 and SSTR-5: Yamada, et al., B.B.R.C. 195: 844-852 (1993)).
  • the actual clones for the SSTR-1 to -3 are available from the American Type Culture Collection (ATCC, Rockville, MD), under the Accesion Nos. ATCC Nos. 79044 (SSTR-1), 79046 (SSTR-2), and 79048 (SSTR-3)).
  • each SSTR cDNA may be excised by suitable restriction endonuclease digestion (See, Maniatis, T., et al., Molecular Cloning-A Laboratory Manual, CSHL, (1982)). Restriction endonucleases are available, e.g., from New England Biolabs (Beverly, MA). The present cDNA fragment was inserted into the mammalian expression vector, pCMV (Russell, D., et al., J. Biol.
  • mammalian expression vectors suitable for use herein include pcDNA1/Amp (Invitrogen, Sandlesy, CA).
  • the expression plasmids were introduced into the suitable bacterial host, E. Coli HB101 (Stratagene, La Jolla, CA) and plasmid DNAs, for transfection, were prepared on Cesium Chloride gradients.
  • CHO-K1 ovary, Chinese hamster cells were obtained from ATCC (ATCC No. CCL 61). The cells were grown and maintained in Ham's F12 media (Gibco BRL, Grand Island, NY) supplemented with 10% fetal bovine serum under standard tissue culture conditions. For transfection, the cells were seeded at a density 1 x 10 6 /60-cm plate (Baxter Scientific Products, McGaw Park, IL.). DNA mediated transfection was carried out using the calcium phosphate co-precipitation method (Ausubel, F.M., et al., Current Protocols in Molecular Biology, John Wiley & Sons, 1987). The plasmid pRSV-neo (ATCC; ATCC No.
  • CHO-K1 clonal cell lines that have stably inherited the transfected DNA were selected for growth in Ham's F12 media containing 10% fetal bovine serum and 0.5 mg/ml of G418 (Sigma). The cells were ring-cloned and expanded in the same media for analysis.
  • Crude membranes were prepared by homogenization of the transfected cells in 20 ml of ice-cold 50 mM Tris-HCl with a POLYTRON homogenizer (setting 6, 15 sec). Buffer was added to obtain a final volume of 40 ml, and the homogenate was centrifuged in a Sorval SS-34 rotor at 39,000 g for 10 min at 0-4°C. The resulting supernatant was decanted and discarded. The pellet was re-homogenized in ice-cold buffer, diluted, and centrifuged as before. The final pellet was resuspended in the 10 mM Tris HCl and held on ice for the receptor binding assay.
  • somatostatin-14 2000 Ci/mmol; Amersham Corp., Arlington Heights, IL
  • 50 mM HEPES 50 mM HEPES (pH 7.4) containing a test somatostatin agonist of various concentrations (e.g., 10 -11 to 10 -6 ), 10 mg/ml bovine serum albumin (fraction V) (Sigma Chemical Co., St. Louis, MO), MgCl 2 (5 mM), Trasylol (200 KIU ml), bacitracin (0.02 mg/ml), and phenylmethylsulphonyl fluoride (0.02 mg/ml).
  • a test somatostatin agonist of various concentrations (e.g., 10 -11 to 10 -6 ), 10 mg/ml bovine serum albumin (fraction V) (Sigma Chemical Co., St. Louis, MO), MgCl 2 (5 mM), Trasylol (200 KIU ml), bacitracin (0.02 mg/m
  • the final assay volume was 0.3 ml.
  • the incubations were terminated by rapid filtration through GF/C filters (pre-soaked in 0.3% polyethylenimine for 30 min) using a Brandel filtration manifold. Each tube and filter were then washed three times with 5 ml aliquots of ice-cold buffer.
  • Ki IC 50 /[1 +(LC/LEC)] where IC 50 is the concentration of test somatostatin agonist required to inhibit 50 percent of the specific binding of the radioligand [ 125 I-Tyr11] somatostatin-14, LC is the concentration of the radioligand (0.05 nM), and LEC is the equilibrium dissociation constant of the radioligand (0.16 nM).
  • Ki IC 50 /[1 +(LC/LEC)]
  • IC 50 the concentration of test somatostatin agonist required to inhibit 50 percent of the specific binding of the radioligand [ 125 I-Tyr11] somatostatin-14
  • LC the concentration of the radioligand (0.05 nM)
  • LEC is the equilibrium dissociation constant of the radioligand (0.16 nM).
  • Table I The Ki values (nm) for the tested somatostatin agonists are shown in Table I below.
  • the cell suspensions were filtered and resuspended in low glucose DME with 10% FBS and antibiotics before seeding in 48-well tissue culture plates ( ⁇ 5 x 104 cells/well; 50-80 wells/tumor) in 0.5 ml medium for 96 hours.
  • the medium was changed before treatment to serum-free defined DME, and the cell cultures were treated for 3 hours with 10-100 nM of the type 2-selective somatostatin agonists BIM-23014 (Lanreotide), BIM-23023, BIM-23190, and BIM-23197, the sequences of which are disclosed in Moreau, et al., Metabolism 45(8):24 (1996), and the type-5 selective somatostatin agonists BIM-23268 and BIM-23052. (6-8 wells for each analog or control (vehicle solution only)), after which medium was frozen for later hormone measurements.
  • Example 9 Treatment of Adenoma Cells with Somatostatin Type-5 Agonists in Accordance with the Invention
  • prolactin-secreting pituitary adenomas Six prolactin-secreting pituitary adenomas were obtained, cultured, and treated with analogues representative of the somatostatin analogues of the invention.
  • Adenoma cells were obtained from large macroprolactinomas of 4 male patients (Patient Tumors 1, 2, 3, and 4). Three of the macroprolactinomas were invasive, and were accompanied by serum prolactin levels over 1,000 ng/ml. The cells from all 4 different tumors responded to treatment with the SSTR-5 selective agonists BIM-23052 or BIM-23268 with suppression of prolactin secretion.
  • the SSTR-2 selective somatostatin agonists Laureotide, BIM-23023, BIM-23190, and BIM-23197 did not affect prolactin release from the adenomatous cell cultures of tumor 1.
  • Prolactin release from tumor 2 cell cultures were inhibited by treatment with 10 nM BIM-23268 (38% versus controls; p ⁇ 0.0005).
  • the four large male tumors also failed to respond to commercially available drugs, such as Octrotide, and Lanreotide, as well as to novel agonists with even higher affinities for the SSTR-2, including BIM-23190, and BIM-23197.

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Claims (32)

  1. Verwendung einer therapeutisch effektiven Menge eines Somatostatin Typ-5 Rezeptor-selektivem Agonisten für die Herstellung eines Medikamentes zum Behandeln von Hyperprolaktinämie in einem Subjekt,
       dadurch gekennzeichnet, daß
       der Typ-5 Rezeptor Agonist ein Peptid umfaßt, das ausgewählt ist aus der Gruppe bestehend aus H-Cys-Phe-Phe-D-Trp-Lys-Thr-Phe-Cys-NH2, H-D-Phe-Phe-Phe-D-Trp-Lys-Thr-Phe-Thr-NH2, und Mischungen daraus; und
       die Menge des zu verabreichenden Agonisten effektiv darin ist, die Prolaktinspiegel bis auf 5 bis 50 ng/ml Blut abzusenken, wenn mit Immunoradiometrie gemessen wird.
  2. Die Verwendung nach Anspruch 1, wobei der Somatostatin Typ-5 Rezeptor Agonist einen Ki kleiner als 1 nM für den Somatostatin Typ-5 Rezeptor hat.
  3. Die Verwendung nach Anspruch 1, wobei der Ki des Somatostatin Typ-5 Rezeptor-selektiven Agonisten für den Typ-5 Somatostatin Rezeptor wenigstens zehnmal niedriger ist, als sein Ki für den Somatostatin Typ-2 Rezeptor.
  4. Die Verwendung nach Anspruch 1 bis 3, wobei der Typ-5 Rezeptor-selektive Agonist H-Cys-Phe-Phe-D-Trp-Lys-Thr-Phe-Cys-NH2 umfaßt.
  5. Die Verwendung nach Anspruch 1 bis 3, wobei der Typ-5 Rezeptor-selektive Agonist H-D-Phe-Phe-Phe-D-Trp-Lys-Thr-Phe-Thr-NH2 umfaßt.
  6. Die Verwendung nach Anspruch 1, wobei die Menge des Agonisten, der verabreicht wird, darin effektiv ist, die Prolaktinspiegel auf etwa 2 bis zu etwa 30 ng/ml Blut zu senken, wenn mit Immunoradiometrie gemessen wird.
  7. Die Verwendung nach Anspruch 1, wobei die Menge des zu verabreichenden Agonisten darin effektiv ist, die Prolaktinspiegel auf etwa 5 bis zu etwa 20 ng/ml Blut zu senken, wenn mit Immunoradiometrie gemessen wird.
  8. Die Verwendung nach Anspruch 1, wobei der Patient einer ist, dem eine Menge eines therapeutischen Mittels ausgewählt aus der Gruppe bestehend aus Bromocriptin, Cabergolin, Pergolid, Lisorid und Kombinationen daraus verabreicht wird.
  9. Die Verwendung einer therapeutisch effektiven Menge eines Somatostatin Typ-5 Rezeptor Agonisten für die Herstellung eines Medikamentes zur Behandlung eines Subjektes, das unter Hyperprolaktinämie verbunden mit Laktation nach der Geburt leidet.
  10. Die Verwendung einer therapeutisch effektiven Menge eines Somatostatin Typ-5 Rezeptor Agonisten für die Herstellung eines Medikamentes zur Behandlung eines Subjektes, das unter durch Drogen hervorgerufener Hyperprolaktinämie leidet.
  11. Die Verwendung nach Anspruch 10, wobei die Droge ausgewählt ist aus der Gruppe bestehend aus Opiaten und psychotropischen Drogen.
  12. Die Verwendung einer therapeutisch effektiven Menge eines Somatostatin Typ-5 Rezeptor Agonisten für die Herstellung eines Medikamentes zur Behandlung eines Subjektes, das an hypothalamischen oder hypophysären Stepiteserkrankungen (stalk disease), verbunden mit hohen Blutspiegeln an Prolaktin, leidet.
  13. Die Verwendung einer therapeutisch effektiven Menge eines Somatostatin Typ-5 Rezeptor Agonisten für die Herstellung eines Medikamentes zur Behandlung eines Subjektes, das an Hyperthyroidismus, verbunden mit hohen Spiegeln an Serumprolaktin, leidet.
  14. Die Verwendung einer therapeutisch effektiven Menge eines Somatostatin Typ-5 Rezeptor Agonisten für die Herstellung eines Medikamentes zur Behandlung eines Subjektes, das an verminderter Dopamin- oder Dopamin-Inhibitoraktion verbunden mit hohen Spiegeln an Serumprolaktin leidet.
  15. Die Verwendung einer therapeutisch effektiven Menge eines Somatostatin Typ-5 Rezeptor Agonisten für die Herstellung eines Medikamentes zur Behandlung eines Subjektes, das an einem Stimulus leidet, der normale dopaminergische Inhibition überwindet, in Verbindung mit hohen Spiegeln an Serumprolaktin.
  16. Die Verwendung nach Anspruch 15, wobei der Stimulus, der die normale dopaminergische Inhibition überwindet, die Verabreichung von Östrogen umfaßt.
  17. Die Verwendung einer therapeutisch effektiven Menge eines Somatostatin Typ-5 Rezeptor Agonisten für die Herstellung eines Medikamentes zur Behandlung eines Subjektes, das an verminderter Prolaktinentfernung leidet, verbunden mit hohen Spiegeln an Serumoprolaktin.
  18. Die Verwendung einer therapeutisch effektiven Menge eines Somatostatin Typ-5 Rezeptor Agonisten für die Herstellung eines Medikamentes zur Behandlung eines Subjektes, das an Nierenversagen oder Zirrhose leidet, verbunden mit hohen Spiegeln an Serumprolaktin.
  19. Die Verwendung einer therapeutisch effektiven Menge eines Somatostatin Typ-5 Rezeptor Agonisten für die Herstellung eines Medikamentes zur Behandlung eines Subjektes, das an Anfällen leidet, die mit hohen Serumprolaktinspiegeln verbunden sind.
  20. Die Verwendung einer therapeutisch effektiven Menge eines Somatostatin Typ-5 Rezeptor Agonisten für die Herstellung eines Medikamentes zur Behandlung eines Subjektes, das an einem Brustwandtrauma leidet, verbunden mit hohen Spiegeln an Serumprolaktin.
  21. Die Verwendung nach Anspruch 1, wobei das Subjekt menschlich ist.
  22. Die Verwendung nach Anspruch 1, wobei das Subjekt an Prolaktinoma leidet.
  23. Die Verwendung nach Anspruch 22, wobei die Menge des Somatostatin Typ-5 Rezeptor Agonisten darin effektiv ist, die Menge an Prolaktin, das durch die Prolaktinoma abgesondert wird, abzusenken, um es in etwa innerhalb der normalen Prolaktin-Blutspiegel zu halten.
  24. Die Verwendung nach Anspruch 22, wobei die Menge des zu verabreichenden Agonisten darin effektiv ist, die Prolaktinspiegel bis zu etwa 2 bis 30 ng/ml Blut abzusenken, wenn durch Immunoradiometrie gemessen wird.
  25. Die Verwendung nach Anspruch 22, wobei die Menge des Somatostatin Typ-5 Rezeptor Agonisten darin effektiv ist, die Prolaktinspiegel bis zu etwa 5 bis 20 ng/ml Blut abzusenken, wenn durch Immunoradiometrie gemessen wird.
  26. Die Verwendung nach Anspruch 22, wobei der Somatostatin Typ-5 Rezeptor Agonist einen Ki für den Somatostatin Typ-5 Rezeptor hat, der kleiner ist als 1 nM.
  27. Die Verwendung nach Anspruch 22, wobei der Ki des Somatostatin Typ-5 Rezeptor-selektivem Agonisten für den Typ-5 Somatostatin Rezeptor wenigstens zehnmal niedriger ist, als sein Ki für den Somatostatin Typ-2 Rezeptor.
  28. Die Verwendung einer therapeutisch effektiven Menge eines Somatostatin Typ-5 Rezeptor-selektivem Agonisten für die Herstellung eines Medikamentes zur Behandlung von Galaktorrhö verbunden mit hohen Prolaktinspiegeln.
  29. Die Verwendung einer therapeutisch effektiven Menge eines Somatostatin Typ-5 Rezeptor-selektivem Agonisten für die Herstellung eines Medikamentes zur Behandlung von Amenorrhö, assoziiert mit hohen Prolaktinspiegeln.
  30. Die Verwendung einer therapeutisch effektiven Menge eines Somatostatin Typ-5 Rezeptor-selektivem Agonisten für die Herstellung eines Medikamentes zur Behandlung von Unfruchtbarkeit, verbunden mit hohen Prolaktinspiegeln.
  31. Die Verwendung einer therapeutisch effektiven Menge eines Somatostatin Typ-5 Rezeptor-selektivem Agonisten für die Herstellung eines Medikamentes zur Behandlung von Impotenz, verbunden mit hohen Prolaktinspiegeln.
  32. Die Verwendung einer therapeutisch effektiven Menge eines Somatostatin Typ-5 Rezeptor-selektivem Agonisten für die Herstellung eines Medikamentes zur Behandlung von Hypergonadismus, verbunden mit hohen Prolaktinspiegeln.
EP98918696A 1997-05-01 1998-04-24 Verfahren zur behandlung von hyperprolaktinämia und prolaktinomen Expired - Lifetime EP0979098B1 (de)

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